Journal of Shahid Sadoughi University of Medical Sciences
Year:2003 | Volume:10 | Issue:4|Papers Count:19

Ocular emergencies if not treated early and correctly may result in blindness. The purpose of this study was to determine the demography, etiology, initial and final VA in patients who were admitted urgently to the Referral eye center of Yazd province. In a retrospective study, the records of all 122 consecutively admitted patients in Rah-Ahan Eye hospital between Mehr 1379 and Mehr 1380 were reviewed. From the total of 122 patients, 67.21% were men and 32.81% women. 54.1% had right eye involvement, 42.6% left eye and in 3.3%, both eyes were involved. Data was analysed by SPSS soft ware .The mean age was 30.6 years (Range 1-79 Years). 41% of those admitted were less than 20 years old. Men had a higher incidence of eye injury than women in all age groups. 47.1% injuries occured at home, while 32% at the work place. The most common type of injury was corneo – scleral laceration. Endophthalmitis (4 %) and enucleation (3.2 %) were the most serious complications. 28.8% patients were admitted 12 hours after injury. Final VA was significantly related to initial VA (P<0.001) .We recommend that similar studies must be done in others cities, and after evalution of datas, instruction for prevention of ophthalmic emergencies should be given to the appropriate population. Use of seat belts, eye protective equipment and glasses is necessary in factories and work places.

Glucose has an important role as fuel in the body and is a source of energy in the form of glycogen, fat, and protein. Neonatal Hypoglycemia is important because sustained hypoglycemia may cause neurological damage, seizures & low IQ. Although the definition of hypoglycemia in the neonate has been controversial, it is advisable to maintain the plasma glucose level above 40mg/dl in all neonates. Infants with SGA, prematurity, asphyxia and newborns of diabetic mothers are at an increased risk of hypoglycemia. In this cross-sectional case control study, we investigated the frequency of hypoglycemia in the high risk and normal neonate groups. We selected 200 neonates and measured their blood glucose levels 4-6 hours post delivery. In this study, hypoglycemia was defined as a blood glucose level below 40mg/dl (2.2mml/litre). The prevalance of hypoglycemia was 29.2% in premature, 37.5% in SGA, 33.4% in infants of diabetic mothers, 16.7% in asphyxia & 29% in healthy term neonates. The study disclosed a 34.8% prevalance of hypoglycemia in normal neonates delivered by cesarian section and 39.5% in high risk neonates delivered vaginally. The frequency of hypoglycemia in SGA neonates was higher than the other neonates. There was no relationship between neonatal hypoglycemia and maternal age and neonatal sex.

Diabetes mellitus is a common endocrine disease with metabolic, vascular and neuropathic complications due to alterations in carbohydrate, fat and protein metabolism, secondary to absent or markedly diminished insulin secretion and/or ineffective insulin action . The aim of this experimental study with clinical trial (Before and After) was investigation of  the effect of vitamin C supplement on decrease of HbA1c in NIDDM patients referring to the diabetes research center of Yazd. FBS, 2HPP,HbA1C and Vitamin C blood level were determined and treatment started with Vitamin C supplementation (250mg/QID) for 6 weeks .The paired T-Test was used for comparing the results in diabetes and control groups. Statistical evaluation revealed that mean HbA1C prior to Vitamin C supplementation was 11.21+1.3 percent that decreased to 9.19+1.3  percent (P@0) after administration. Not only a direct relationship existed between primary HbA1C&FBS , but also with Vitamin C blood levels before treatment, after third week, (p@ 0.002 ) and 9 weeks (p @ 0.02). It is therefore postulated that the antioxidant effect of Vitamin C decreases HbA1C levels and with attention to the high blood levels of Vitamin C after interruption, it is suggested that for compensation of low blood levels of Vitamin C in diabetic individuals they should be administered Vitamin C supplements.    

The astonishing renaissance of herbal medicine in our country and also all over the world renders a review of this topic timely. Particular emphasis should be placed on the efficacy and safety of herbal treatments. The reasons for consumers to turn to herbal medicine are complex and differ according to many factors. The daily press is biased strongly in favor of herbal medicine. Other factors include; perceived safety, naturality, accessibility, rejection of science and technology, desperation, ineffectiveness and adverse effects of certain common drugs. We conducted a before-after trial for evaluation of one of these herbal remedies; Artemisia extract produced by Barij Essence Company, which according to the drug leaflet, has an antiasthmatic effect. Our cases were 11 healthy volunteers and 19 asthmatic patients. Instruments included a questionnaire and a forced expiratory volume maneuver done by American Thoracic Society Standards. The questionnaire was filled and spirometry was done before and 5, 15, and 30 minutes after nebulization of Artemisia extract. Treatment effects were tested by student t-test. No clinically or statistically significant effect was detected after Artemisia extract administration. We therefore concluded that in spite of factory claims, Artemisia extract has no clinically or statistically significant effect on asthma recovery.

Human T Lymphotropic virus type I (HTLV-I), discovered in 1980, is considered to be the etiologic agent of adult T – Cell Leukemia/ Lymphoma (ATL) and spastic paralysis. This lymphoproliferative malignancy, occuring in the high endemic areas for HTLV-I (Japan, The Caribbean, South America, parts of Africa and Iran, especially Khorasan province located in the north east of Iran) is characterized by CD4 positive lymphocytes associated with a monoclonal integration HTLV-I provirus in the tumoral cells. The retrovirus is transmitted mainly by blood transfusion and body fluids (sexual routes, breast feeding). The purpose of this study was to determine the prevalence rate of human T-lymphotropic virus –I (HTLV-I) in 100 leukemia / lymphoma patients, 200 thalassemia patients and 500 blood donors. No antibody to HTLV-I was detected in leukemia/ lymphoma patients. From among the thalassemia patients who had had more than 10 blood transfusions, 6(3%) had antibodies to HTLV-I while 7(3.5%) were suspected cases. Only 1 out of 500 (0.2%) blood donors had antibodies to HTLV-I. According to this study, the prevalence rate of HTLV-I in Shiraz is low and therefore screening test is not necessary.

In this clinical trial, 100 patients who underwent elective abdominal and inguinal hernia surgeries at Kerman university hospital were selected randomly. The patients were divided in two groups; 50 patients, opium addicted and 50 patients, non opium addicted patients. The day before surgery at 8 o'clock, the cortisol serum level in the two groups was measured using imiunoassay. The duration of recovery period and post anaesthetic complications were compared.  Serum cortisol levels in 50 addicted patients were as follows: less than normal in 17 (34%) patients; more than normal in 5(10%) patients and normal in 28 (56%) patients. The low levels of serum cortisol were related to the duration and severity of opium addiction but they were not significant from the statistical point of view. The cortisol level in the other group was normal (100%) X2=20.13, PV= 0.34. The post-anaesthetic complications and withdrawal syndrome, especially pain and shivering in the recovery room were more in the opium addicted patients as compared to the other group. (PV<0.0001, X2=25). The duration of recovery period after cessation of anaesthesia was less in opium addicted patients as compared to non addicted patients and this was significant from the statistical point of view. It is therefore concluded that opium addicts (PV<0.0002, X2=26) are high risk patients for elective surgery, and special attention must be given for successful anaesthesia in these patients.

Breath Holding Spells are an important and common phenomenon in childhood. Their importance is because of the clinical aspects which are worrying for the parents and the fact that they can be misdiagnosed as a ‘seizure disorder’. This problem is prevalent between 6 months and 2 years of age which is the same age for prevalence of iron deficiency anemia and there is a possibility of a connection between these two problems. In this article, we evaluated this relation and observed 32patients with breath holding spells referring to Mofid hospital over one year. We treated those patients with ferrous sulfate and studied its effect on the spells.We found a connection between the severity of iron deficiency and breath holding spells in these patients and also the effectiveness of iron therapy in reducing the frequency of breath holding spells. This conclusion is interesting because of the following two facts: 1-A new management can be considered for children with breath holding spells which has no special therapy at present. 2- Breath holding spells can be used as an important factor to detect iron deficiency anemia so that certain diagnostic and therapeutic plans can be implemented. Lastly, we hope that this article is informative and helps our collegues to understand and resolve this important phenomenon in children.

Exercise test is an important tool for diagnosing coronary artery diseases and determining its prognosis in affected patients. However, remarkable achievements have been brought about by coronary angiography for diagnosing coronary artery diseases. Hence, any new methods that can improve the sensitivity and diagnostic efficacy of the exercise test will result in improved easy diagnosis of cardiovascular disease in affected patients. Exercise test was conducted for 218 patients (130 men and 88 women) aged between 30 and 74 years (mean age = 50 ± 7 years), all of whom ultimately underwent coronary artery angiography. Exercise test was conducted using V4r instead of V2 chest lead, and the other 11 standard chest leads. Results of the exercise tests were analyzed by SPSS (Chi square). 103 of 148 patients with significant coronary artery stenosis (more than 75% stenosis of cross sectional area) had positive exercise test results in standard chest leads. Exercise test electrocardiogram of 25 patients revealed positive findings, both in V4r and in the other 11 standard chest leads. 15 patients displayed positive exercise test findings solely in V4r. Of 218 patients studied, 148 suffered from more than 75% stenosis of arterial cross sectional area of one or more coronary arteries. Adding V4r to the other standard chest leads in exercise test raised its sensitivity from 69.5% to 80%. Using V4r chest lead in exercise test resulted in increased sensitivity of this procedure for diagnosing left circumflex artery and right coronary artery disease, however, sensitivity remained unchanged for diagnosing diseases of other coronary artery branches.

In the last two decades, the use of progesterone as a long acting contraceptive has been recognized and advances have been made in this field where in the drug is either implanted subdermally as a capsule or injected deep intramuscularly. In this cross sectional study, 200 women used norplant (implant) and 200 women used depot injections for one year. The side effects and level of acceptance was studied in the population under study. Blood spots or bleeding and amenorrhea were seen in both the groups. In the norplant group, 50% had blood spotting and 28% had amenorrhea, while in the depot injection group, 42% had spotting and 23% had amenorrhea. After a period of one year, only 75% continued using norplant, while 50% continued using depot injections. Taking into consideration the similarity of side effeects in both the groups, it is advisable to initially administer depot injections to check for patient compliance and side effects before using norplant thus avoiding unnecessary costs and norplant use in those who cannot tolerate the drug. An important point to note is that due to side effects like blood spotting and irregular bleeding, it is not favoured by muslim women.

Leishmaniasis is one of the most common infectious diseases in the world, especially in Iran. The most common treatment is glucantime, a drug related to pentavalant antimoanat. This drug has many side effects such as: GI symptoms, ARF, arrhythmia, pancreatitis, increase in liver enzymes and BUN/Cr levels, but the effect of this drug on the blood indices is not clear. This study was performed on patients referring to Nikoopour clinic in 1380. Method of this study was retrospective and type of study was before and after treatment on patients with cutaneous leishmaniasis as diagnosed form direct smear from ulcer. Patient who had an underlying disease such as hematological disorders, DM and those who were using corticosteroids was omitted from the study. Blood samples for complete blood count were taken before treatment with glucantim (20 mg/kg/ day for 20 days IM). CBC/diff was measured again on the last day of treatment and results of blood indices were compared with Paired t.test. Results showed that use of glucantim led to decrease in RBC, PLT, WBC, MONO, Hb,Hct counts (P<0.05) and increase in the lymphocytic counts, (P<0.05). The PMN, MCH, EOS counts were decreased while MCV, MCHC counts were increased but not statistically significant (P<0.05). Also, age and sex had no effect on the test results (P<0.05). We therefore recommend that CBC/diff be performed for patients with leishmaniasis before treatmnet and in case of hematologic disorders, another treatment such as cryotherapy or hyperthermia, should be performed. Another important point is that patients with co- infection or those on corticosteroids should not be administered glucantime.

Prevention of progressive joint destruction in rheumatoid arthritis (RA) requires continous treatment and methotrexate (MTX) is usually recommended for this purpose. This study was performed to determine the efficacy and toxicity of long-term MTX therapy in RA. Low – dose MTX was administered at weekly dosage of 7.5 – 10 mg to 22 patients ( 19 females , 3 males ) with active RA for an average period of 56 + 15 ( 25 – 75 ) months . Disease variables such as painful joints count , swollen joints count , duration of morning stiffness ; functional capacity , disease activity (DA) , erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) were assessed at baseline and at the end of the study period and compared by Wilcoxone signed rank test. A significant decrease from the baseline was observed in all disease variables throughout the study period.The number of  painful joints count decreased from 14.9 + 7.7 at the baseline to 2.3 + 3.1 at the end  of the study period, ( P< 0.00001 ); the number of the swollen joints from 7.2 + 4 to 1.4 + 1.8 ( P= 0.002) ; duration of morning stiffness from 119 + 69 to 27 + 50 minutes (P< 0.0003) ; functional capacity from 2.6 + 0.7 to 1.7 + 0.5 ( P=0.007) ;DA from 2.3 + 0.5 to 1.1 + 0.9 ( P< 0.007) ; ESR from 43.5 + 39.7 to 26.6 + 21.4 mm/h ( P< 0017) ; and CRP from 2.5 + 0.8 to 0.8 + 1.3 ( P < 0.012). The mean dosage of prednisolone decreased from 6.5 + 4.3 mg/day at the baseline to 3 + 2.4 mg at the last visit ( P = 0.002 ). Clinical improvement was seen in 59%, while disease remission developed in 23% of the patients. Five types of drug toxicity were observed in 41% of patients, but none of them were withdrawn from the study because of  drug toxicity. Long – term MTX therapy in RA can induce clinical improvement in a large number of patients with no significant toxicity and may cause a decrease in either the number of patients taking conticosteroids or its dosage.

Streptolysin O is a cytolytic and immunological protein secreted extracellularly by streptococci group A and streptococci group C and G. Streptolysin O (SLO)is secreted along with other toxins like streptolysin S, artherogenic toxin, isoenzymes and mutagens  during log phase growth of most of streptococcal strains A , C and G. SLO is a protein of 60-70 KD molecular weight, oxygen labile and is inactivated by oxidation. SLO is antigenic and is present in the blood of patients infected with streptococci and leads to the production of antistreptolysin O which can be used for diagnosis of advent of the disease. The aim of this study is to further the economic independence of our country by using a simple method of production of streptolysin O and antistreptolysin O kits in the country. For this study, Richard's standard strain (code A-78, Institute Pasteur, Paris, France) was grown in a combination medium composed of veal Infusion broth II. After overnight incubation, the medium was centrifuged to separate the bacteria and the supernatant was precipitated by ammonium sulfate. The precipitate was dissolved in DW and after dialysis, passed through a DEAE cellulose column. Different fractions were collected and their anti- SLO activity was checked. From the fractions, those possessing the highest anti SLO activity had 53000 U/ml and 3 bands between 69-72 KD on SDS PAGE stained with silver. A comparative study was carried out with commercial SLO available in Iran (Scalvo) and very good results were obtained. It should be stated here that this antigen was approved by the Iranian Reference Laboratory.  

Strongyloides stercoralis (ss) is an intestinal nematode which infects a large proportion of tropical and subtropical population. We present a 61 old resident of Gheshm Island with temporal arthritis who was immunosuppressed due to corticosteroid treatment for 6 months. He had a history of military service in Kuwait, ten years ago. The patient presented with fever, malaise, vomiting and delirium, which was unresponsive to conventional treatment. On examination, mild tenderness in epigastric region was observed and neck rigidity was absent.  On endoscopy, diffuse erosion of the mucosa was seen. Diagnosis was made from duodenal biopsies, wherein many strongyloides stercoralis larvae in the glandular mucosa of duodenum with mucosal erosion and neutrophil and eosinophil infiltration were seen. Blood smear did not show any eosinophilia. Stool was negative for larvae & sputum was negative for BK and larvae. Patient was treated with thiabendazole 25 mg/kg orally BID. The patient was completely well after 5 days of treatment with no adverse side effects.

In April 2001, an 85 year old woman was investigated for viral markers following ascitis. The results proved her to be a hepatitis B surface antigen carrier. In the next stage, all her children were tested for HbsAg and 6 out of the 7 children were HbsAg positive. Investigations were carried out for the later generations of the family. In these investigations, 32 new positive cases of HbsAg were detected. The age of  the carriers ranged between 11 and 85 years. 19 cases were female and 13 were males respectively. Among all the reported carriers, only one case was cirrhotic, while another reported to having  icterus about 10 years ago, but was presently free of  any clinical signs and symptoms.